Squamous intraepithelial lesions arising in benign endocervical polyps: a report of 9 cases with correlation to the Pap smears, HPV analysis, and immunoprofile

Clinicopathological Characteristics of Squamous Cell Carcinoma and High-grade Squamous Intraepithelial Lesions Involving Endocervical Polyps

BACKGROUND/AIM

To investigate the clinicopathological characteristics of high-grade squamous intraepithelial lesions (HSILs) and squamous cell carcinomas (SCCs) involving endocervical polyps (ECPs).

PATIENTS AND METHODS

We collected the endocervical polypectomy cases and performed pathological examination and cytohistological correlation.

RESULTS

During a period of 12 years, 21 (1.1%) HSILs and two (0.1%) SCCs involving ECPs were identified in 1,905 cases. Twelve (63.1%) of the 19 cases were cytohistologically concordant. In five HSILs and one SCC with polypectomy margin involvement, residual HSIL was identified in conization or hysterectomy specimens. Furthermore, in two HSIL patients and one SCC patient with negative polypectomy margins, residual HSILs were found in the conization specimens.

CONCLUSION

The prevalence of HSIL and SCC involving ECP in our cohort was similar to the rates found in previous studies. The presence of residual HSIL in nonpolypoid cervical tissue regardless of the polypectomy margin involvement suggests that conization or hysterectomy is needed for diagnostic or treatment purposes.

Deciphering the Multifactorial Susceptibility of Mucosal Junction Cells to HPV Infection and Related Carcinogenesis

Human papillomavirus (HPV)-induced neoplasms have long been considered to originate from viral infection of the basal cell layer of the squamous mucosa. However, this paradigm has been recently undermined by accumulating data supporting the critical role of a discrete population of squamo-columnar (SC) junction cells in the pathogenesis of cervical (pre)cancers. The present review summarizes the current knowledge on junctional cells, discusses their high vulnerability to HPV infection, and stresses the potential clinical/translational value of the novel dualistic model of HPV-related carcinogenesis.

Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis

OBJECTIVES

This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict 'incorrect diagnosis" in general practice.

METHODS

A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions.

RESULTS

The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1).

CONCLUSIONS

All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.

Asymptomatic cervical polyps: can we just let them be?

AIM

Routine polypectomy is still practiced in many settings. The objective of this study was to establish the frequency of dysplasia or malignancy found in cervical polyps from a multiyear sample after abnormal specimens performed for indication were excluded.

MATERIALS & METHODS

This is a retrospective study of the pathology results from 2006-2013, inclusive.

RESULTS

The study included 898 polyps from 854 nonpregnant women, after the 17 abnormal specimens from women who presented with complaints of abnormal bleeding or for evaluation of abnormal cytological tests were excluded; none of the 898 specimens showed any significant abnormalities. The results did not vary by patient age or polyp size.

CONCLUSION

Routine removal of cervical polyps in asymptomatic women with current, normal cervical cytology testing is unwarranted because it adds little to their management and it has the potential to cause harm.

Comparison of dysplastic and benign endocervical polyps

OBJECTIVE

This study aimed to estimate dysplasia rate in histologically evaluated endocervical polyps and to compare histological and clinical characteristics of dysplastic (D) polyps with those displaying representative benign changes.

MATERIALS AND METHODS

Endocervical polyps removed at Mayo Clinic from January 1994 to December 2010 were categorized as polyp without other descriptors, benign polyp variants, adenomatous or reactive atypical (AR) polyps, and D polyps. Clinical characteristics, cervical cytological result, and polyp histological result of patients in the latter 2 categories were compared.

RESULTS

Among the 4,328 patients with endocervical polyps, 3,656 were classified as polyp without other descriptors, 628 as benign polyp variants, 34 as AR polyps, and 9 as D polyps. Dysplasia was mild in 4 polyps, moderate in 1 polyp, and severe in 4 polyps. Overall risk of dysplasia was 0.2%. Patients with D polyps were younger (mean = 40.3 vs. 49.8 years, p = .009) and more likely to have abnormal cervical cytological result before polyp removal (67% vs. 21%, p = .014) as compared with those with AR. Patients with D polyps tended to have a polyp greater than 20 mm (44% vs. 15%, p = .074) compared with those with AR polyps. Associated endometrial pathological diagnosis was limited to a prolapsed endometrial polyp in 1 patient and submucosal endometriosis in 1 patient.

CONCLUSIONS

Patients with D polyps were younger and had a greater likelihood of abnormal cytological result before polyp removal. No polyp size threshold below which dysplasia could be excluded was identified. No primary cervical cancer, endometrial hyperplasia, or cancer was identified.

Is removal of asymptomatic cervical polyps necessary?: histologic findings in asymptomatic Israeli Jewish women

OBJECTIVE

: The purpose of the present study was to assess the frequency of abnormal histologic findings in polyps of asymptomatic Israeli Jewish women who are known to have a low incidence of cervical neoplasia.

MATERIALS AND METHODS

: The medical records of Israeli Jewish women with histologically proven cervical polyps treated during 2005 to 2009 in 2 Maccabi Health Service clinics that specialize in cervical pathology and colposcopy were retrieved from a computerized database. The records of asymptomatic women who underwent polypectomy were reviewed, and demographic information, clinical information, and the presence of abnormal colposcopic patterns, cervical intraepithelial neoplasia (CIN), and malignancy were abstracted.

RESULTS

: The study included 228 asymptomatic women with cervical polyps who underwent colposcopy. Their median age was 49 ± 10.9 years (range = 21-82 y). The highest percentage of patients was observed in the 40- to 49-year-old age group, was Israeli-born, and was married. The percentage of patients referred because of an abnormal cytology report (29.4%) was considerably higher than the percentage reported in Israeli Jewish women. Abnormal colposcopy patterns were seen in 9 polyps, and CIN was found in 6 of them. Despite the high frequency of abnormal cytologic smears, CIN 3 was detected in only 1 polyp (0.4 %). In none of the polyps was malignancy found.

CONCLUSIONS

: The very low frequency of neoplasia in cervical polyps of asymptomatic patients seems to support the notion that there is no clear indication for polypectomy when cytology is normal.

Clinical parameters associated with unsatisfactory specimens of conventional cervical smears

Although The Bethesda System 2001 attempted to standardize the criteria for specimen adequacy, much confusion still exists, which includes the significance of unsatisfactory smears, the causes and clinical conditions related to unsatisfactory smears, and the appropriate management of unsatisfactory smears. The aim of this study is to find out the clinical factors associated with unsatisfactory cervical smears. We reviewed the medical charts of patients who received conventional Pap smears between March 2006 and August 2006 in a tertiary care center. After excluding 378 cases with incomplete demographic data, the clinical data of 7,059 cases were processed for analysis. Clinical parameters retrieved included: history of pelvic malignancy, pelvic irradiation, conization, hysterectomy, pregnancy status, within 3-months postpartum. Vaginal bleeding, abnormal vaginal discharge, intrauterine device, and cervical polyps found during pelvic examinations were also documented. The 1,397 cases with history of pelvic irradiation, pelvic malignancy, and hysterectomy were excluded. Finally, 5,662 cases were enrolled for data analysis. The relationship between clinical parameters and unsatisfactory smears were analyzed by Pearson's chi-square test with Yates' continuity correction and multivariate binary logistic regression test. The incidence of unsatisfactory smears was 4.5% (252/5,662). Clinical parameters correlated with unsatisfactory smears were postpartum status (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004), vaginal bleeding (OR = 2.02, 95% CI = 1.30-3.16, P = 0.002), and endocervical polyps (OR = 2.62, 95% CI = 1.39-4.947, P = 0.003). In conclusion, if any of these parameters are noted prior to obtaining a Pap smear, optimal collecting devices, better sampling techniques, and liquid-based cytology should be considered to decrease the incidence of unsatisfactory smears.